Chronic Myeloid Leukemia (CML) in A 14-Year-Old
DOI:
https://doi.org/10.59141/jiss.v7i5.2328Keywords:
child, anemia, leukocytosis, splenomegaly, myeloid cell predominanceAbstract
Chronic Myeloid Leukemia (CML) is a myeloproliferative disorder accounting for approximately 2-3% of leukemias in children and adolescents, with an annual incidence of 1 in 1,000,000 individuals (approximately 10% of all CML cases). The median age of onset in children is 11-12 years. CML is caused by a reciprocal translocation of genes on chromosomes 9 and 22, resulting in the formation of the Breakpoint Cluster Region (BCR) gene on chromosome 22 with the Abelson leukemia virus (ABL) gene. The BCR-ABL protein has constitutive tyrosine kinase activity, leading to the activation of intracellular signal transduction pathways such as STAT, RAS, JUN, MYC, and Phosphatidylinositol-3 kinase. This case report concerns a 14-year-old girl with CML, a rare hematologic malignancy in children. The patient presented with abdominal enlargement and hardening for 2 months, abdominal pain, fever, and vomiting. Physical examination revealed splenomegaly (Schuffner 4). Laboratory tests revealed anemia (hemoglobin 7.3 g/dL) and leukocytosis (291,890 WBCs/mm³). Peripheral blood smear showed myeloid blasts and all stages of granulocyte maturation with basophilia and eosinophilia. Bone marrow aspiration confirmed chronic myeloid leukemia in the chronic phase with an M/E ratio of 25.5. BCR-ABL molecular testing revealed positive fusion of B2A2 and B3A2. This case highlights the aggressive presentation of pediatric CML characterized by massive splenomegaly and extreme leukocytosis, which differs from adult CML. Early recognition and timely diagnosis are essential to prevent disease progression and life-threatening complications such as leukostasis, bleeding, and splenic rupture.
References
Al-Qerem, W., Bataineh, L., Jarab, A., Eberhardt, J., Alasmari, F., & Hammad, A. (2025). The development of national growth charts for Jordanian children aged 0–2 years. Frontiers in Pediatrics, 13, 1547581.
Berman, E. (2022). How I treat chronic-phase chronic myelogenous leukemia. Blood, The Journal of the American Society of Hematology, 139(21), 3138–3147.
Ford, M., Mauro, M., Aftandilian, C., Sakamoto, K. M., & Hijiya, N. (2022). Management of chronic myeloid leukemia in children and young adults. Current Hematologic Malignancy Reports, 17(5), 121–126.
García-Gutiérrez, V., Breccia, M., Jabbour, E., Mauro, M., & Cortes, J. E. (2022). A clinician perspective on the treatment of chronic myeloid leukemia in the chronic phase. Journal of Hematology & Oncology, 15(1), 90.
Held, N., & Atallah, E. L. (2023). Real-world management of CML: outcomes and treatment patterns. Current Hematologic Malignancy Reports, 18(5), 167–175.
Huang, M., Wang, L., Lou, Y., Qiu, Z., Yu, S., & Xuan, F. (2025). Temporal trends in cancer mortality attributable to high BMI in Asia: An age-period-cohort analysis based on GBD 1992–2021. Frontiers in Endocrinology, 16, 1691487.
Iqhrammullah, M., Rampengan, D. D. C. H., Amri, I., Lastri, S., Rampengan, S. H., Prakoso, R., & Habiburrahman, M. (2025). Monetary Valuation of Congenital Heart Disease in Indonesia: Economic Modeling Study. JMIR Pediatrics and Parenting, 8(1), e80696.
Millot, F., Ampatzidou, M., Moulik, N. R., Tewari, S., Elhaddad, A., Hammad, M., Pichler, H., Lion, T., Tragiannidis, A., & Shima, H. (2025). Management of children and adolescents with chronic myeloid leukemia in chronic phase: International pediatric chronic myeloid leukemia expert panel recommendations. Leukemia, 39(4), 779–791.
Nevejan, L., Labarque, V., & Boeckx, N. (2024). Chronic myeloid leukemia (CML) in children and adolescents—Clinicopathological findings. European Journal of Haematology, 112(3), 458–465.
Sembill, S., Ampatzidou, M., Chaudhury, S., Dworzak, M., Kalwak, K., Karow, A., Kiani, A., Krumbholz, M., Luesink, M., & Naumann-Bartsch, N. (2023). Management of children and adolescents with chronic myeloid leukemia in blast phase: international pediatric CML expert panel recommendations. Leukemia, 37(3), 505.
Senapati, J., Jabbour, E., Kantarjian, H., & Short, N. J. (2023). Pathogenesis and management of accelerated and blast phases of chronic myeloid leukemia. Leukemia, 37(1), 5–17.
Suttorp, M., Sembill, S., Kalwak, K., Metzler, M., & Millot, F. (2023). Priapism at diagnosis of pediatric chronic myeloid leukemia: data derived from a large cohort of children and teenagers and a narrative review on priapism management. Journal of Clinical Medicine, 12(14), 4776.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Catherine Halim, Leonardo Trisnarizki, Sisca Sisca
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International. that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
